An Overlooked Solution while Caring for Aging Loved Ones

You are listening to Boomers Today with your host Frank Samson. Well, welcome to Boomers Today. I’m your host, Frank Samson. Of course, each week we bring you important and very useful information on issues facing baby boomers, their parents, and other loved ones.

And as I do on every one of our shows, I thank all of you. And the reason I’m thanking you is because so many of you are sending our podcasts, our individual shows to friends and families to listen to, and that’s why our listeners keep growing each and every day. Many of you listen to the show on Apple podcast, Spotify, our Heart Radio, Audible, or some of you just ask Alexen or Siri to take you to Boomers Today. So thank you so much for that, and I really appreciate it, and I know that we appreciate it because we continue doing the show and bringing on great guests.

And I’m not going to disappoint you today because we have with us Bill Zigorski, who is a CEO of And by the way, Bill, I pronounced your last name correctly on perfect All right, great? So Bill is the CEO of American Senior Care Center Incorporated, overseeing Centennial Adult Care centers, three adult day healthcare centers, home care, transportation and case management services serving adults throughout Middle Tennessee. He also serves as the Research Committee Chair and is the immediate past board chair of the National Adult Day Services Association, as well as the president of the Tennessee Association of Adult Day Services on the Tennessee Federation for the Aging. So, Bill, thank you so much for being on the show. Really appreciate it.

I appreciate the opportunity. Thanks for having me. Frank. Yeah, so, you know, maybe maybe we could just start out tell us a little bit more.

And you know, people always ask me how I got into the industry, so I’m going to ask you as well. You know, how’d you get involved in the industry, especially with Centennial, and you know how you became involved in the adult day services business. Absolutely, I mean it’s a long and winding road. We might need, you know, twenty or thirty minutes just to go, but I’ll give that, you know, a thirty thousand foot overview.

Actually, Centennial Oak Care Centers American Xenior Care was founded by my parents in nineteen ninety one. I was eleven at the time. Maybe outdate myself, but yeah, we opened in nineteen ninety one, and honestly I had you know, I was young, I was in grade school. I had no idea what it was or really what they were doing.

But my father had a vision to all individuals to age and place. And my grandmother had moved in with us. She had moved from Chicago to Nashville, and she had attended a Social Model day program around that time, and unfortunately, in those types of programs, a lot of times individuals who had dementia that was progressing and they needed medication or incontinence care were no longer appropriate for attendance. So when we we opened as the first Medical Model adult day program in Tennessee in nineteen ninety one, again I was eleven.

I continued to have a high school education. I went off to college, and my career was actually in scientific research, academic research and cancer biology and immunology. And absolutely love the bench top research. But I got really tired of writing grants.

So about fifteen years ago, my wife and I took an opportunity to move back here. Centennial had been open for twenty years. My parents were you know, still operating the company, but I had never taken a business class or knew nothing about it other than the actual function of what we did and who we served, and and took that opportunity. So I fell in love with it really quickly.

We opened, We had one center open at that point in time, did a lot in the home care space, look in the transportation space. Since then, I again, I love collaborating. I love, you know, de siloing the industry and serving individuals. We’ve since open to other locations.

We’re still in the home care space. We still do some transportation as well as case management. And and I mean I have a problem saying no, So anytime someone asked me to help with another organization or another board or another you know, association, I generally say yeah. So I love this industry.

I love being able to help individuals live at home for the rest of their lives and and do this in a way that is you know, affordable and rewarding to participants, to caregivers, and to organizations like like Centennial All Care as well. So that’s the really quick overview. That’s great, that’s great. Well, thanks for all you do.

That’s wonderful. So, you know, I’ve been in the industry for a while and I know I know many families aren’t that familiar with adult day care. When when our company has senior care authority, any of our advisors around the country bring it up. You know, sometimes families go adult day care.

Tell me more about that. So why don’t you explain exactly what it is and who it’s designed to help? Absolutely, you know, I’ve done I couldn’t count count how many dozens or hundreds of presentations, and whether you’re talking locally or nationally, the general of the title is adult day service is the best kept secret and long term care. It is truly the best kept secret to you, not to the credit of anyone trying to keep it a secret. But again is people don’t really know what adult day care is or adult day services are.

There’s been a big push over the past, you know, twenty years to really stop using the term adult daycare just because that’s the nomenclature people know. But the infantilizing terminology is you know, does detract from the breadth of services that are provided. But adult day services are regulated differently in every single state, so there is no federal payer. Hence it’s a pretty fragmented environment.

If you’ve been to one adult day program. You’ve been to one adult day program. There’s between seven and ten thousand locations across the United States. You know, it is not a you know, a highly sorry, it is a highly fragmented industry.

But working with the National Adult Day Service Association, it came very clear that there’s no single definition, so we spent a lot of time really kind of painting it with a broad brush to get an inclusive definition that was released, you know, about two years ago, in twenty twenty four. But in general, adult day services it is a system of professionally delivered, integrated home and community based therapeutic, social health related services provided to individuals to sustain living in the community. And that really encompasses everything that happens and everyone that is served. It serves individuals from eighteen to well over one hundred, certainly with a focus in the aging space, but it is not where it was you know in the late seventies that have focused on the dementia population.

It really is focusing on anybody that can’t live at home by themselves, and the services are designed to provide you know, some social and health related services in a supervised environment outside the home during the day while rely while giving the caregiver of the much needed break from that twenty four hour a day job of being a caregiver and returning home to sleep in their own home at night for as much of the rest of their lives as possible. And it’s not like there is not a wealth of senior living organizations that do a fantastic job, but not everybody can afford them, and there’s not payers that pay for services all the time too. So if we can span the gap, allow individuals to age in place as long as possible, then allows for the services to be delivered in a person centered manner. So it really serves anybody that can’t stay at home by themselves safely and the caregiver that needs a little bit of a break.

That’s the general population. Yeah, what you said at the very end there is you know, my understanding is giving that caregiver or break. It could be you know, of course, that family caregiver. Maybe maybe they just need a break, maybe they’re working, whatever the case may be.

But would you say that that’s the majority of the cases. Absolutely. I mean, caregiving is a twenty four hour a day, seven day a week, generally thankless and well underpaid position to work in and you know, especially caring for a loved one as you watch them age or or you know progress with a chronic condition. I mean the level of chronic stress and caregivers is through the roof.

There’s been studies that show, you know, the incidents of cortisol levels is sustained at a level that is just it’s unsustainable and leads to detrimental health and health outcomes. But caregiver is not just need but absolutely deserve a break and whether again, like you said, being you know, if they’re still working, it allows you know, you people to remain in the workforce. If it’s for somebody that’s retired or not working, it still allows them to get the break they need to be involved in the community and work in the community, volunteer or just sit down and relax. I mean they don’t need to do the job twenty four to seven.

I mean somebody needs to be able to help. So yes, I mean caregivers need and deserve that break and deserve that time for themselves as well. So I know you’re in the in home care business as well, so maybe you could help. And I’m sure every situation is going to be different, of course, but maybe you could generally explain where it might be advantageous for the family to have a caregiver come to the house and you know, provide.

You know, they might providing care, could be just companionship, whatever the case may be, versus coming to an adult day care center, George, when when would you suggest one over the other? And and it’s difficult to say, it’s really going to vary person by person, but often that that home care delivery could be a little bit early in the content, earlier in the continuum of care. So it might be just a caregiver that needs help, you know, with some baiting assistance, or often the home care services are more appropriate for individuals that are living alone, for individuals and in subsidized housing that might have other chronic conditions, and so it’s a few hours a day or a few times a week to come in with some some homemaking and cleaning support or errands or or you know, grocery grocery delivery, assistance with cooking and cleaning and laundry. But you know, again it’s it’s a one on one level of service that provides you know, that interactive you know, the interactive approach, and generally for individuals with a caregiver. Those caregivers do still need a break, but it could be you know, an hour a couple of times a week to get ready or to combine with transportation and case management.

Where you look at adult day services are more the holistic, you know area of care where people are able to attend a you know, a peer a peer supportive environment that’s really engaging from a you know, a therapeutic standpoint. But in a social environment, there’s also individuals who really just do not thrive in a group of environment by personal choice, and home care might be more appropriate for those individuals. However, you know, social isolation and loneliness leading to geriactric depression. I think geriatric depression itself is one of the leading causes of death, and it has been equated to whether it’s smoking two or three packs of cigarettes a day.

So you know, adult day alleviates that social isolation and loneliness and then reduces geriatric depression. But again it’s not for everybody. So I really see home care as earlier on the spectrum, you know, the non medical home care. Also, I see it more appropriate in the post acute discharge space for individuals that might need support as the standards episodes of care with home health rehab home based rehab then progress and still need an additional support that Medicare may not be paying for.

So it’s it’s kind of a combination of But if you look at more of a continuum look care, I look at home care, non medical home care earlier on the spectrum. Got it. So what do you think are some of the biggest misconceptions families have about adult day care centers? You know, I’ve said it many times. I’ve been quoted after attribute to some of my friends, Doc Contina, Side Around Ghana and Lydia and Miss Aliti’s in California.

But adult day is more than just dancing and dominoes. And I don’t want to belittle dancing and dominoes. It’s great, you know, so it’s very fun. But adult day is truly a system of professional, integrated services.

You know, senior centers are more you know, appropriate for self initiating individuals that are able to deliver themselves to and from and you know, not self isolates and are self initiating. Where adult Day is truly a system of you know, integrated scheduled activities that are led by group staff. Often included things like you know, art therapy and music therapy, movement therapy, activities of you know, the assistance with activities of daily living. It is delivered by professional staff.

There’s often nurses on staff to help with medication management that usually include some sort of case management, product care management, medication assistance. Generally, adult day services, especially when you get to the medical adult day services or medical model, receive and individuals receive the same level of care that they could or would receive in a nursing facility, except it’s at a quarter of the cost. It’s the least restrictive environment, and they still are able to receive you know, return home at night too. So it’s it’s really more of a very professional setting in a social, engaging, supported environment with an environment of their peers.

And that’s the biggest thing. People are there because they want to be there. People attend because they enjoy being around their peers, and they might, you know, have a sense of purpose there. They might believe, especially an individual with moderate dementia, they I’ve had individuals that think they’re coming to teach and there’s a gentleman that I gave a paycheck to every two weeks.

Now again those paychecks were not real checks. But mister Tom came for a dozen years and he got a paycheck because he thought he was a teacher. So it’s that sense of purpose, the sense of engagement, the sense of meaning that people receive in the adult environment, on top of the services that are provided for them as well. So it’s a combination of everything, you know, what there’s.

You know, when when you hear adult daycare, you know you start thinking of people are probably more familiar with child daycare, all right, and in child daycare, you know, maybe the parents working, it’s before they’re you know, they’re young, before they’re ready for school. They drop them off in the morning, pick them up and they have to noon or whatever the case may be. Right, what kind of flexibility is there with adult day Is it worth the same way or hey you could just drop somebody, you know, have somebody there for a couple of hours, or what’s kind of the norm and what’s the flexibility? Sure and gain it’s similar to the same fragmented environment, but it’s the same general philosophy of you know, dropping the child off in the morning and picking them up in the afternoon. Most programs are incredibly flexible, so there’s generally no minimum required days of attendance, and if there is a requirement for minimum days of attendance, it might be two days a week or more.

They generally try to schedule, and especially individual programs that really focus on on Alzheimer’s a related disease population would probably prefer a schedule not just for the staffing but for the members that are attending, so that there’s a regular engagement at regular friendship. But in general, there’s not a minimum number of days that have to be attended unless there’s a threshold for that for that organization. There’s generally not a minimum number of hours that can be attended. Depending on the payer, of course, and if it’s in the private population, a day a per dem reimbursement or a per diem charge.

If you attend for an hour, it’s going to be the same as attending for eight hours. There’s also a number of programs that operate on drop in basis on an hourly charge. You generally have to go through some background enrollment paperwork just to make sure that that program knows who’s coming, But once that member is enrolled, more often if you’re attending at least once every six months. Then you’re at your file is going to be archived and stay or sorry, it won’t be archived, it’ll stay active and individuals are able to attend as they see fit.

Usually ask for a twenty four hour notice of somebody coming in, so it’s not just dropping in without notice. But once you’re enrolled, it’s generally pretty open and quite flexible. Also, more than half of programs it’s in the fee for service space, so it’s a program that might be a prepaid schedule. But if you’re canceling days because you have doctor’s appointments, you’re out of town, it’s not usually not like the childcare space.

Quite often those days are then credited back to the future you, so it may not be refunded in cash, but they’re often credited for future you. So it’s not like the childcare space where it’s you’re enrolled for five days, even if your child’s there for three and you’re still paying for five days. It’s very different in the adult day space. Yeah great, great, So Bill, we’re going to take a quick break promised just about a thirty second break, just to recognize our sponsor.

We come back certainly a lot more I want to learn, and maybe you’ll be able to share with us some of the ways people can learn about services like yours and other parts of the country as well, because not everybody’s in Nashville, you know. That’s great, all right? So a question for all of you, do you know anyone who may be concerned about an older driver well senior care authorities. Beyond Driving with Dignity program is a facilitated self assessment program for older drivers. This program has been designed to serve as a vital tool to facilitate older drivers and their families as they make the appropriate decisions regarding the future of one safe driving career.

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That’s Beyond Driving with Dignity dot Com and you could connect with a senior care authority advisor in your area. We’re back now with Bill Zigorski, is a CEO of American Senior Care Center Incorporated. We’re learning a whole lot about adult daycare. So Bill, why don’t you share a couple of things you know, certainly anything you would like to share about your service, website, anything like that, and then maybe you could address how people can learn more about services like yours in different parts of the country.

I’m more than happy too, I really appreciate the opportunity. Frank and So Centennial Adult Care Centers is our operating name. There’s the Medical Model Adult Day Programs, so that we operated in Middle Tennessee. I’d mentioned earlier.

We opened in nineteen ninety one. We’re still one hundred percent family owned and operated organization. My wife and I currently work in the program and own the program and continue to grow in this state. We mentioned where we were the first Medical model adult day program in the state of Tennessee.

We have nurses on staff to be able to care for individuals and provide care for individuals of all ages and diagnoses, so we are an aid and diagnosis agnostic program across across our centers. We care for individuals as young as eighteen currently as old as one hundred and three. Previously, our oldest individual was one hundred and eleven. Before mister Wilber left our program, not passed away, he just wasn’t able to come.

He lived over one hundred and thirteen. We do focus on providing care for individuals in that sixty to ninety range. About half of our members have some sorts of cognitive diagnosis, whether it be in Alzheimer’s related dementia. We do a lot in the post CBA post stroke environment to really care and provide services for individuals that have had a stroke and are on working to stay and remain independent in their own home, and then a subset of individuals with intellectual and developmental disabilities.

But truly, we’re an organization that is going to be a peer in someone’s own flesh and blood, someone that’s going to be a similar individual, a similar state of mind, and a similar personality. We’re also right, like I mentioned, a therapeutic adult day program. I was lucky enough to receive a grant about a year and a half ago to add in our music and movement therapy into all of our programs and we’ve sent since integrated that into our daily operations and stuff. Now we’re a medical model with therapeutic activities offered at all of our centers every single day, and we basically bounce back and forth between a cognitive stimulating game, a therapeutic activity, and a physical activity to keep people active, engaged, and functional throughout the day.

With that, the staff that provides services and care and supports and of course in the South, we eat a lot too, So yeah, there’s a breakfast, lunch, and afternoon snack and it’s a it’s a lot of fun. I know I’m not on video, but I don’t I don’t miss the meal myself either. You can find out a lot more about us on our website. It is www dot Centennial Adultcare dot com and that’s Centennial ce n T E n N I a adultcare dot com.

We’ve been in business for for thirty five years and I certainly would love to be able to pass this on to my children, but I have a few more years before they’re old enough, and hopefully they don’t make the same decision to stay away for fifteen years before they come back either. You know, you mentioned there’s there’s a number of state associations that operate, you know, state based organizations. I chair the Tennessee Association with All Day Services. There’s about forty five programs across the state of Tennessee.

More information to be found at TADS dot net, t A A d S dot net. And then primarily I’m just rolled off as the board chair, but I’m still the research committee chair for the National Adult Day Service Association, representing the industry across the United States. More information there can be found at NASA dot org and it’s NADSA dot org and as an organization that again represents the entire depth and breadth of the adult day services industry across the US. And there’s depending on who you as, there’s somewhere between four thousand and ten thousand locations across the United States.

But it’s really that seven to nine thousand range of adult day programs in the respite, social, medical, specialized, therapeutic kind of continuum of adult day across the US. So there’s something for everybody, and it’s continuing the industry that’s really continuing to grow. So I’m curious you had mentioned that there’s a wide range as far as how many there are, aren’t they license? Are they licensed by the particular state like assisted living is licensed by each state? And if so, then how come they don’t know? How come the exact number is not known. It’s a great question.

I’ve been lucky enough to work with CDC working on the National Post Acute Long Term Care Survey, that empower survey, that does that annual assessment. The challenge is, since there’s no federal payer and there’s no federal definition, each state gets to define what adult day services is. At the moments in twenty twenty six, I believe there’s thirty seven states that do license adult day one way or another. It could be a single level of licensure for adult day services, it could be multiple levels or social model, medical model, dementia dementia adult day.

Of the remaining thirteen states, I think a few of them either credential or certify programs for utilization in the Medicaid programs. But I believe there’s still seven states that actually do not have any type of licensure for adult day So there is a pretty wide variety. And that also because the definition changes from state to state. That’s where you get that discrepancy in account because the requirements to be included in the Center for Disease Control and POUSE survey is fairly stringent, so they’re published.

Their published count of adult day programs is only for license and certified programs and also does not include a number of the faith based and the rest of organizations, so it’s it’s kind of a subset of about two thirds of the entire environment. So that’s why their published numbers are about four thousand ish, give or take. Where the reality is is probably closer to seven to eight thousand, right. Now, great, good, But I guess I asked the question and I really got into the weeds here you New Year’s thank you? So yeah, so I did want to zero And I know you mentioned you have you know, clients, families that you work with whose loved one has been diagnosed with some form of dementia like Alzheimer’s.

So how do you separate you know, if you separate it, you know, I do you separate people from others who don’t? Does it depends on their level of care? How are your I guess caregivers at your on your staff trained to work with people with that with that disease? Sure? Absolutely, and it certainly can be a challenge. I do not believe in segregation or isolation. So we have an integrated program for individuals. Like I said, all ages and diagnosis, So all of our members are you know, in the same area and receiving the same levels of support, but everything’s in a person centered manner.

Individually, we might have two or three different activities going at any given time, where individuals are able to choose what they want to do, when they want to do it, who they want to do it with. And that might be a you know, a trivia based game. There might be individuals that are that are playing cards with you know, with with support. There might be a chair volleyball or you know, a chair based yoga game all going on at the same time.

So individuals are able to choose what they want to do when they want to participate. But really what we do is uprate and train our staff with behavioral redirection. So we believe in engagements on a person level. So an individual that might have moderate to advance dementia, that has a history of being either a teacher or a caregiver or an accountant, you know, my staff knows who that person is.

They know what the disease state is, but they know who that person is, so they’re able to engage that individual on a one on one level, and if there’s some agitation or behaviors, or if there’s wandering, then my staff are able to engage with that person and talk to them and coordinate with them and redirect them back to a group environment or to ask them and be able to communicate with them in a way that they’re able to express their needs. And that’s the greatest joy in adult day is that the majority of providers are able to utilize behavioral redirection techniques. There’s never blocking techniques, there’s never physical or chemical restraints in adult day. It’s it’s unilaterally disbarked and again it really goes against that person’s centered care environment that we all share across the adult day space.

So yeah, it can be a challenge at times, but it’s really rewarding. Great. Great, So uh on four, I just looked at the time and unfortunately we’re running out of time here, so I could talk to you for for quite a while. It’s great chatting with you.

Maybe one thing I don’t want to have happened that we finish up the interview and you were thinking yourself. Boy, I wish Frank would have asked me this. So I’m going to leave it up to you. What do you what would you like to share with our with our listeners on any subject matter, whether it’s somebody you know maybe about to make a decision after hearing this.

Uh uh, you know this podcast? You know, what are the steps that they should be taking or anything else that you’d like to talk about. Absolutely appreciate that. You know, the biggest question again, some people don’t know what adult day services are. If you hear this podcast and you’re interested, go visit your local adult program, find one in your area through whatever means, through a Google search or Gemini or anything else, find one in your area and just stop in just to know what they’re share what you find out.

You know. The other question that people wonder is what’s the cost of it and who pays for it? Unfortunately, it’s not something that health insurance generally pays for, and Medicare generally does not pay for services either, although there is the new Guiding Improved Dimensional Experience that does pay for a small subset for individuals with traditional Medicare and a dimentia diagnosis, but there’s a number of payers across the space, primarily the Medicaid the DA pays for adult day services Older Americans. ACTS funds are usually available through your area agencies on agent and disability. Generally private pay.

It represents between ten and twenty percent of the total revenues in this industry and is still the least restrictive and most affordable, averaging less than one hundred dollars per day for adult day services. So I really encourage people just to go visit to get to know what’s available in their area. And it’s not necessar tell even for what you need at the moment, but just to know what you might want in the future. So take a moment to look around, explore, walk in and see what’s available.

Great. Great, Thank you so much for joining us, Bill, Bill Zigorski with American Senior Care. Check it out Centennial Adult Case Centers in Nashville, or you can go to NADSA dot org to check on adult daycare in your area. You’ve been listening to Boomers Today with Frank Samson.

To learn more about today’s show, visit Boomerstoday Radio dot com and join us next time for another edition of Boomers Today.

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